ABSTRACT
Objective / background: Here, we described the clinical characteristics and outcomes of central nervous system [CNS] infections occurring after allogeneic hematopoietic stem cell transplantation [allo-HSCT] in a single institution over the previous 6 years
Methods: Charts of 353 consecutive allogeneic transplant recipients were retrospectively reviewed for CNS infection
Results: A total of 17 cases of CNS infection were identified at a median of 38 days [range, 10- 1028 days] after allo-HSCT. Causative pathogens were human herpesvirus-6 [n = 6], enterococcus [n = 2], staphylococcus [n = 2], streptococcus [n = 2], varicella zoster virus [n = 1], cytomegalovirus [n = 1], John Cunningham virus [n = 1], adenovirus [n = 1], and Toxoplasma gondii [n = 1]. The cumulative incidence of CNS infection was 4.1% at 1 year and 5.5% at 5 years
Conclusion: Multivariate analysis revealed that high-risk disease status was a risk factor for developing CNS infection [p = .02], and that overall survival at 3 years after allo-HSCT was 33% in patients with CNS infection and 53% in those without CNS infection [p = .04]
ABSTRACT
An 81-year-old woman sustained a fracture of the vertebra, resulting in grace deformation. After surgery for the spinal fixation, she suffered from left femoral neuropathic pain and motor weakness of both lower extremities. Daily repetitive transcranial magnetic stimulation (rTMS) of the lower extremity area in the right motor cortex was applied using a figure-8 coil connected to a magnetic stimulator (MagPro R30；Nagventure)．One thousand pulses per session were delivered (10 trains of 10Hz for 10 seconds with 25-seconds intertrain interval) in one day, and this treatment continued for 2 weeks except Sunday. The intensity of rTMS was set at the resting motor threshold for that day. rTMS together with physical therapy resulted in a remarkable amelioration of the femoral pain and motor weakness of both lower extremities. Pain on a Visual Analogue Scale dropped from 70％ to 22％, and walking speed and walking rate increased. Functional Independence Measure score increased from 58 to 79, and Euro QOL 5 score increased from 0.419 to 0.768. As previously reported in cases of post-stroke pain and motor weakness, rTMS together with physical therapy exerted measurable beneficial effects on intractable pain and motor weakness caused by spinal orthodontic fixation.
ABSTRACT
Six (1.2%) of 501 patients sustained phrenic nerve injury during operation for congenital heart disease at our institutions between 1992 and 1998. The diagnosis was confirmed by percutaneous stimulation of the phrenic nerve. All but 1 patient were less than 9 months old, and the average weight was 3.6kg. All 6 patients underwent diaphragmatic plication and were extubated by 7 days after operation. Percutaneous stimulation of the phrenic nerve allowed direct assessment of phrenic nerve function which was difficult to detect by clinical and radiological evidence. This method can be non-invasively used at the bedside to facilitate early and accurate diagnosis of phrenic nerve palsy.